DOI: 10.1111/jocd.15947 ISSN:

Self‐perception of natural outcome, appearance, and emotional well‐being after OnabotulinumtoxinA treatment for upper facial lines: Post hoc analysis across age and gender

Steven Dayan, Patricia Ogilvie, Charles Boyd, Koenraad De Boulle, Maurizio Cavallini, Julia K. Garcia, Maria Musumeci
  • Dermatology



OnabotulinumtoxinA (onabotA) is indicated for upper facial lines (UFL). Fear of unnatural‐looking outcomes is a frequently reported treatment barrier.


Examine patient‐reported outcomes (PROs) after onabotA treatment for UFL.


A post hoc analysis was conducted on two 12‐month pivotal studies of onabotA for forehead and glabellar lines (20 U each), with/without treatment of crow's feet lines (±24 U). This analysis used PROs from the Facial Line Satisfaction Questionnaire: Items 4 (natural look), 5 (treatment effect), 11 (met expectations), and Impact Domain (appearance and psychological impact). The analysis included 458 neurotoxin‐naive adults achieving a ≥2‐grade improvement in UFL severity on the Facial Wrinkle Scale at Day 30 (primary endpoint). Data were further stratified into millennials and men.


At Day 30, 90.5% of all participants, 94.6% of millennials, and 85.7% of men were satisfied with receiving a natural look. Millennials had higher odds of being satisfied with natural outcomes at Day 30. This measure remained > 80% for all groups throughout the 12 months. Additionally, ≥80% were satisfied with the treatment effect, and >90% reported results met expectations. At Day 30, ≥50% reported positive impacts on self‐perceived appearance and psychological well‐being, but millennials had higher, and men had lower odds of reporting these improvements.


Participants achieving a ≥2‐grade improvement in UFL severity after onabotA reported high satisfaction with natural outcomes and the treatment effect, with improved self‐perceived appearance and psychological well‐being. These results may help aesthetic providers and patients address fears regarding unnatural results with onabotA.

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